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If you've been dealing with a tooth that needs to be removed—or it's already missing—you may be looking to replace it with a dental implant. And it's a great choice: No other restoration can provide the appearance and function of a real tooth like an implant.

You and your smile are ready for it. The question is, though, are your gums and underlying bone ready? These dental structures play a critical role in an implant's stability and eventual appearance. A problem with them may make placing an implant difficult if not impossible.

An implant requires around 2.0 millimeters of bone thickness surrounding the implant surface for adequate support and to minimize the chances of gum recession. But tooth loss often leads to bone loss that can drop its thickness below this threshold. This can make placing an implant problematic.

Fortunately, though, we may be able to address the lack of sufficient bone through bone grafting. By placing grafting material within the empty socket, we create a scaffold for new bone cells to grow upon. Over time this subsequent growth may be enough to maintain an adequate thickness of bone for an implant to be placed.

The gums may also pose a problem if they've shrunk back or receded from their normal positions, as often happens because of gum disease (which may also have precipitated the tooth loss). Again, grafting procedures can help ensure there's adequate gum coverage for the implant. And healthier gums may also help protect the underlying bone from loss.

There are several techniques for placing gum tissue grafts, depending on how much recession has taken place. One procedure in particular is often used in conjunction with implant placement. A small layer of synthetic collagen material or gum tissue referred to as pa dermal apron is included with the implant when its placed. Settling into the bone socket, this apron helps thicken the gum tissues, as well as preserve the underlying bone.

During your preliminary exams, we'll assess your bone and gum health to determine if we should take any steps like these to improve them. It may add some time to the implant process, but the end result will be well worth it.

Professional Hockey player Keith Yandle is the current NHL “iron man”—that is, he has earned the distinction of playing in the most consecutive games. On November 23, Yandle was in the first period of his 820th consecutive game when a flying puck knocked out or broke nine of his front teeth. He returned third period to play the rest of the game, reinforcing hockey players’ reputation for toughness. Since talking was uncomfortable, he texted sportswriter George Richards the following day: “Skating around with exposed roots in your mouth is not the best.”

We agree with Yandle wholeheartedly. What we don’t agree with is waiting even one day to seek treatment after serious dental trauma. It was only on the following day that Yandle went to the dentist. And after not missing a game in over 10 years, Yandle wasn’t going to let a hiccup like losing, breaking or cracking nearly a third of his teeth interfere with his iron man streak. He was back on the ice later that day to play his 821st game.

As dentists, we don’t award points for toughing it out. If anything, we give points for saving teeth—and that means getting to the dentist as soon as possible after suffering dental trauma and following these tips:

If a tooth is knocked loose or pushed deeper into the socket, don’t force the tooth back into position.

If you crack a tooth, rinse your mouth but don’t wiggle the tooth or bite down on it.

If you chip or break a tooth, save the tooth fragment and store it in milk or saliva. You can keep it against the inside of your cheek (not recommend for small children who are at greater risk of swallowing the tooth).

If the entire tooth comes out, pick up the tooth without touching the root end. Gently rinse it off and store it in milk or saliva. You can try to push the tooth back into the socket yourself, but many people feel uneasy about doing this. The important thing is to not let the tooth dry out and to contact us immediately. Go to the hospital if you cannot get to the dental office.

Although keeping natural teeth for life is our goal, sometimes the unexpected happens. If a tooth cannot be saved after injury or if a damaged tooth must be extracted, there are excellent tooth replacement options available. With today’s advanced dental implant technology, it is possible to have replacement teeth that are indistinguishable from your natural teeth—in terms of both look and function.

And always wear a mouthguard when playing contact sports! A custom mouthguard absorbs some of the forces of impact to help protect you against severe dental injury.

National Physical Fitness & Sports Month in May, sponsored by the President's Council on Sports, Fitness & Nutrition, is a fitting time to encourage us to play sports. Many of us already feel the Spring itch to get out there and get involved. Unfortunately, an increase in sports or exercise activities also means an increase in potential physical injury risks, including to the face and mouth.

Although COVID-19 protective measures are delaying group sports, there's hope that many leagues will be able to salvage at least part of their season. If so, you should know what to do to keep yourself or a family member safe from oral and dental injuries.

First and foremost, wear a sports mouthguard, a plastic device worn in the mouth to reduce hard impacts from other players or sports equipment. A custom-fitted guard made by a dentist offers the best level of protection and the most comfortable fit.

But even though wearing a mouthguard significantly lowers the chances of mouth injuries, they can still occur. It's a good idea, then, to know what to do in the event of an oral injury.

Soft tissues. If the lips, cheeks, gums or tongue are cut or bruised, first carefully clean the wound of dirt or debris (be sure to check debris for any tooth pieces). If the wound bleeds, place some clean cotton gauze against it until it stops. If the wound is deep, the person may need stitches and possible antibiotic treatments or a tetanus shot. When in doubt, visit the ER.

Jaws. A hard blow could move the lower jaw out of its socket, or even fracture either jaw. Either type of injury, often accompanied by pain, swelling or deformity, requires medical attention. Treating a dislocation is usually a relatively simple procedure performed by a doctor, but fractures often involve a more extensive, long-term treatment.

Teeth. If a tooth is injured, try to collect and clean off any tooth pieces you can find, and call us immediately. If a tooth is knocked out, pick it up by the crown end, clean it off, and place it back into the empty socket. Have the person gently but firmly clench down on it and call the office or go to the ER as quickly as possible. Prompt attention is also needed for teeth moved out of alignment by a hard blow.

Playing sports has obvious physical, mental and social benefits. Don't let an oral injury rob you or a family member of those benefits. Take precautions and know what to do during a dental emergency.

Gum recession is a serious oral condition in which the gums shrink back or “recede” from their normal position around the teeth. Because they're the primary protection for teeth below the enamel, this can expose the teeth to infection or cause painful sensitivity. And receded gums most certainly can diminish your smile.

But there are preventive measures you can adopt that might help you avoid this unpleasant condition. Here are 4 things you can do to minimize your risk for gum recession.

Practice daily oral hygiene. The main cause for recession is gum disease, a bacterial infection that weakens gum attachment to teeth. Gum disease usually arises from dental plaque, a thin bacterial film that builds up on teeth. Removing it every day with brushing and flossing minimizes the risk of gum disease and gum recession.

But don't overdo it. Although brushing is key to keeping your mouth healthy, too hard and too often can damage your gums and lead to recession. A little “elbow grease” may be appropriate for other cleaning tasks, but not your teeth—use gentle strokes and let the mild abrasives in your toothpaste do the main removal work. And avoid brushing more than twice a day.

See your dentist regularly. Your personal care efforts are a major part of preventing gum recession, but you can greatly increase the effect with professional dental care. That's because with even the best hygiene practice infections and other gum problems can still arise. You may also have inherited thinner gum tissues from your parents that increase your disease risk and bear closer monitoring.

Act quickly at the first signs of disease. Gum disease is a progressive disease, and it doesn't take long for it to become intrenched. The sooner it can be treated, the less likely you'll experience recession. So, make a dental appointment as soon as possible if you notice your gums are swollen, red or painful, or if they bleed easily after brushing.

There are ways to reverse gum recession. But many treatments like grafting surgery to regenerate new gum tissues can be quite involved and expensive. Following these tips can help you avoid gum recession altogether or stop it before it goes that far.

Tooth decay is one of the most common diseases in the world, nearly as prevalent as the common cold. It’s also one of the two major dental diseases—the other being periodontal (gum) disease—most responsible for tooth and bone loss.

Tooth decay begins with high levels of acid, the byproduct of oral bacteria feeding on food remnants like sugar. Acid can erode tooth enamel, leading to a cavity that will require removal of decayed material around it and then a filling.

Sometimes, though, decay can spread deeper into the tooth reaching all the way to its core: the pulp with its bundle of nerves and blood vessels. From there it can travel through the root canals to the bone. The continuing damage could eventually lead to the loss of the infected tooth.

If decay reaches the tooth interior, the best course of action is usually a root canal treatment. In this procedure we access the pulp through the crown, the visible part of the tooth, to remove all of the diseased and dead tissue in the pulp chamber.

We then reshape it and the root canals to receive a filling. The filling is normally a substance called gutta percha that’s easily manipulated to conform to the shape of the root canals and pulp chamber. After filling we seal the access hole and later cap the tooth with a crown to protect it from re-infection.

Root canal treatments have literally saved millions of teeth. Unfortunately, they’ve gained an undeserved reputation for pain. But root canals don’t cause pain—they relieve the pain caused by tooth decay. More importantly, your tooth can gain a new lease on life.

But we’ll need to act promptly. If you experience any kind of tooth pain (even if it goes away) you should see us as soon as possible for an examination. Depending on the level of decay and the type of tooth involved, we may be able to perform the procedure in our office. Some cases, though, may have complications that require the skills, procedures and equipment of an endodontist, a specialist in root canal treatment.

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